Provider Demographics
NPI:1578626206
Name:MCFADDEN, MELISSA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SHERBORN LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4224
Mailing Address - Country:US
Mailing Address - Phone:314-409-7409
Mailing Address - Fax:
Practice Address - Street 1:2750 SHERBORN LN
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4224
Practice Address - Country:US
Practice Address - Phone:314-409-7409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001694201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical